ENOUGH! The public health establishment is conspicuously failing to recognise the risks associated with its preferred policy responses to e-cigarettes: with not having e-cigarettes, with banning snus, with prohibiting vaping in public places, with confusing people about risks, with controlling everything. They carry on as if these risks are zero or somehow not their responsibility – but they are all plausible and all end in more smoking and more cigarette sales. We need to press them much more assertively on the risks they create and the harms their ideas may do:

“do you accept these risks are plausible and can you see how and why they might arise?”

“what evidence do you have regarding these risks?”

“what make you so confident your policy ideas will not cause more harm than good?”

“at what level of risk would you stop advocating these policies, or at least call for more evidence?”

For almost every policy idea there is for regulating harm reduction, there is a realistic risk that it will make things worse for health. And for almost every theoretical risks from vaping, there is a more plausible theoretical benefit. Let’s consider the following:

1. Insisting on pharmaceutical regulation. Do advocates of pharmaceutical regulation regulation like ASH and Royal College of Physiciansreally know enough to be sure that their policy would not dramatically reduce the diversity of products available, raise costs, smother innovation and deny some users the products they find most effective as alternatives to smoking? Yet their preferred policy comes with that major risk, and with the consequence that more people may smoke more cigarettes and the toll of disease and death will be higher. Have they ever acknowledged this risk or shown that they are willing to accept responsibility for adverse consequences arising from their policy preferences? I have seen little evidence that the recognise this risk as something very serious and potentially significantly larger than the risk they are trying to address.

2. Banning vaping in public places. Organisations like the BMA, Public Health Wales and Faculty of Public Health seem to have never considered that their policy in favour of banning vaping in public places may diminish the value proposition for switching to e-cigarettes from smoking and cause more smokers to persist with smoking. Have they ever accepted that sending vapers outside to join the smokers may cause more relapse to smoking? Where is their account of the potential lost benefits that might arising from normalising vaping in public places, and thereby encouraging more smokers to switch? They are totally silent on these points, have no evidence to suggest these risks are nugatory and accept no responsibility for the harmful consequences that might arise.

3. Disinformation. It is staggering that such a high proportion of smokers believe that vaping or smokeless use is no less hazardous than smoking, or not much less. Have any of the privileged but unaccountable academics in public health ever recognised that they may be culpable in misleading people into remaining as smokers because they are unsure whether there is any risk reduction or much benefit? Or that they have been inspired to fear hypothetical risks that have negligible magnitude? When Professors Glantz, Daube, McKee and Chapman sign up to a letter full of falsehoods, half-truths, misrepresentations and spin, do they worry that the chain of events that flow from this might leave yet more people dying of cancer and heart disease? I’ve never seen any recognition that the likely outcome of opposing products 95-100% less risky than smoking might be harmful. Or that they have even the slightest sense of responsibility for the harmful consequences of their propaganda war.

4. Advertising that scandalises them. There’s lots of public health advocates quick to be offended by edgy e-cigarette advertising or to declare that it is aimed at children and should be banned. But are they accounting for the risk that this sort of advertising actually works well with the target market (and doesn’t usually include them) and may drive more switching – a positive health gain. It’s hard to prove, except that is generally what the advertisers are trying to achieve and the e-cigarette category is growing rapidly – so something is working. Has Cancer Research UK reviewed its hostile stance on e-cigarette marketing and considered the idea that there are risks with banning or severely restricting e-cigarette advertising – and these may mean that more people will smoke? I must confess I have never seen any of the public health establishment weigh this up.

5. Banning snus. A bunch of creepy Brussels-based ‘health’ lobbyists went and told the European Commission in 2012 that snus should remain banned in the new directive. The EU duly obliged, fortified by support from these wholly unaccountable, unrepresentative and harm-inducing public health zealots, whatever the vast body of evidence and expert opinion says to the contrary. But did these supposedly experienced tobacco control advocates pause to consider that denying people outside Sweden access to snus might lead to their death? Have they taken on board the risk that denying what has been so positive for health in Sweden and Norway might actually cause harm in the rest of the EU? You see ‘we just don’t know’… that is, they don’t know whether their actions are causing harm (they almost certainly are) but somehow they don’t feel accountable for this. None of those involved in getting snus banned in 1992 has seen fit to resign or apologise following the success of snus where it has been allowed. I’ve already discussed the negligence James Reilly and the other politicians that agreed the snus ban in the EU Council.

6. Smoking cessation services shunning e-cigarettes. Have the people behind the (NICE) guidance on tobacco harm reduction actually considered that their guidance may be causing net harm? In limiting the use or recommendation of e-cigarettes through UK Stop Smoking Services to only licensed medicines, they may have denied smokers the choice of products that could be effective in getting them to switch from smoking to vaping. Worse still, they may actively dissuading people from trying e-cigarettes who have come in to ask for advice on quitting. Has the health risk associated with the pedantic of requirement that only products licensed as medicines can be used in Stop Smoking Services ever been considered? If the restriction had been lifted or never imposed, maybe there would have been more successful switchers. We may not know the answer to this question, but it is a risk to health – and one likely to be far greater than the benefit to health arising from the insistence on only using licensed products. So who is taking responsibility for these risks?

7. Protecting the children. There is almost universal consensus, including almost the entire e-cigarettes and tobacco industry, that under-18s (let’s call them adolescents rather than children) should not have access to e-cigarettes. But have they recognised the risk here? In the US we know that over 15% of high school students smoke cigarettes (in the last 30 days). But for these smokers why should harm reduction start at 18? Why deny them ‘harm reduction’ alternatives? How do the supporters of this policy assure themselves that e-cigarettes do not function as an alternative to smoking and divert young people away from smoking onset in their teens? It hardly unprecedented because that’s what happens with snus in Sweden and Norway. So all the people who like to use children as a force majeure argument that justifies just about anything – how do they know they aren’t increasing the risk that more kids will smoke?

8. Banning ‘kiddie’ flavours. How much care have they taken to check how many adults like flavours that are supposedly ‘targeted at children’? Have they made any estimates of whether fewer adults will take up or stick with vaping if they are denied these products? How did they decide that adolescents would be attracted to childish flavours, rather than adult flavours? It’s not obviously the case: kids do adult things to emulate adults, not to assert their childishness. So an unproven assertion about flavours targeting children, may lead to more harm in adults… where is the public health recognition of that?

9. E-cigarettes: it’s Lights all over again. This analogy is precisely wrong and designed to cause harm. With light cigarettes, there was no reduction in harm but regulators encouraged smokers to believe there was. With snus and e-cigarettes, there is a dramatic reduction in risk, but regulators seem determined to conceal this important fact from smokers. How much responsibility do the users of this sleazy rhetorical device take for the misinformation built into it? How responsible do they feel for any smokers who says “well I won’t get fooled again” and continues to smoke? What effect do they expect this analogy to have? It’s not a rare occurrence: recently 129 badly informed public health establishment figures wrote to the WHO to make this point:

Public health embraced cigarette filters and “low tar” cigarettes as harm reduction strategies before manufacturers provided evidence and at a time when the manufacturers were well aware that these technologies did not actually reduce harm but were designed to promote cigarette sales by reassuring a concerned public that the new products were safer.

Really… it’s not the same – but it is misleading and therefore potentially harmful to imply it is.

10. Saving or killing the Spanish smoker? Following a campaign of black propaganda and know-it-all doctors talking bollocks about e-cigarettes in Spain, ‘health campaigners’ appear to have achieved a huge decline in vaping. Presumably a ‘victory’ for a certain kind of campaigner – but how many of them are scrutinising the consequences for those Spanish citizens no longer vaping? Are they smoking again? Are the health people involved even bothered?

11. Legal bans on e-cigarettes. Presumably in the nicotine idiocracies of Australia and Canada where they have outlawed most form of e-cigarette commerce while allowing sale of cigarettes, the policy intent would be to have no-one vaping at all… do any of the ‘giants of tobacco control’ in these countries ever cast their eye over the extremely positive statistics from the UK and just have one moment of doubt that they may be preventing something similar happening where they are? In UK 700,000 e-cigarette users are ex-smokers? What are the numbers for Australia and Canada – and who is willing to take responsibility for the missing vapers?

12. Strength limits for liquids. (H/T Sarah Jakes) – so to somehow protect people from nicotine poisoning that they aren’t actually in any danger from to start with, a limit should be placed on the strength of liquids on the market? But have they considered that the stronger liquids are more important for people making their initial switch and may be more important for the more nicotine dependent smokers? So who in public health shouted out about the risks from this limit. Some scientists did, but the wasn’t much to be heard from the public health establishment. And staying quiet is not much different to supporting it.

13. Black markets and DIY (H/T Sarah Jakes). All these campaigners who want bans or hard restrictions are really just saying they would rather the supply was through the grey or v black market or people took the initiative and make their own, with what flavours, strengths and volumes they bloody well want. This is a classic constraint of the unfettered bossiness of regulators and health campaigners – push them too far, raise costs too much, restrict choice too much and the consumer will defect – and a willing but illegal or quasi-legal supply chain will meet their needs – possibly with far greater risks than would have been incurred had there been no regulation at all. So the activists who want to sharply constrain or ban e-cigarettes – where is the calculation of the risks arising from a black market? Or are they just wishing that away? Update – great post on this subject by Carl Phillips 4th July: Predicting the black market in e-cigarettes. He lists six options open to vapers after introduction of highly restrictive (FDA) regulation:

Use the regulated mass-market cigalike products that FDA approves?

Vape zero-nicotine liquid?

Return to smoking?

Switch to another nicotine source like snus, and perhaps continue to vape zero-nicotine liquid?

Continue to buy hardware and buy the liquid you want on the black market?

Continue to buy hardware and try to make your own liquid, by adding pure nicotine to zero-nicotine liquid, or from scratch?

Of course, FDA, MHRA, EU, WHO have made no assessment of which of these models would predominate – and whether risks and harms would in fact increase overall. They probably just hope that people will quit altogether if they can’t get nicotine in the form they like. Even if the regulators could shrug and shirk responsibility and claim it’s a law and order issue, a real public health perspective takes into account what people actually do, even if that is illegal or mad.

Finally… of course, chronic harm arising from the steady debasement of trust in public health and harmful consequences that might arise when they do have something legitimate to say – a point well made here:

@Clive_Bates Broader risk: I 4 1 no longer believe “public health”; they lie about #ecigs, & so what else? Can’t be trusted about anything.

Who amongst the public health industry is recognising that the unprofessional and anti scientific behaviour of those few zealots is harming the public trust in their entire message, with all the consequential damages caused by that?

So there you have it: it is time that the naysayers, ANTZs, bossy doctors, risk-averse regulators, prudes and prohibitionists were challenged much harder on the risks they create, the harms they cause and the protection for the cigarette industry that they provide. It wouldn’t be so bad if the risks they created were risks to their health, but they need to be more accountable for the risks they impose on others: it’s not them that bear the consequential harms arising from their misjudgements, ideological posturing and responsibility shirking. Any other examples of the creation of health risks by the public health establishment? In the comments please…

Nice work! I think it could also be useful for everyone to know how and where to fill a form online. You’ll forget about paperwork when you try PDFfiller. SC 5027-A can be filled out in 5-10 mins here http://goo.gl/tuYYsf

[…] harm reduction is being easy on harm. It should be obvious that there are dangers here. See: Turning the tables on public health – let’s talk about the risks *they* create from July 2014, or my table mapping likely unintended consequences […]

[…] policy impacts agenda: what adverse or unintended consequences could poorly designed regulation, policy or communications have (generally manifest as more smoking than there otherwise would be)? With the introduction of the EU […]

The current DEA inspired spike in Heroin use in USA is perfect example of what happens when a corrupt agency (DEA) conspires to cement their own survival by denying the populace alternative ameliorations(in this case pain-killing meds) through propaganda and fear mongering.

I’m afraid I’d have to agree with Peter here, the DEA and of course, all other drug agencies, have their main agenda as preserving their own ends. Of course, this applies to all other government agencies.

Which is precisely why we NEED, we MUST, get rid of as much regulatory poppycock as soon as is humanly possible.

Too many lives are ruined or otherwise compromised without an acceptable reason all because someone somewhere wants something that they cannot otherwise obtain without forcing someone to do their bidding for them.

It’s time we all woke up. Somebody is cleaning up. Somewhere else somebody is paying dearly for it through no real fault of their own.

It’s also time to grow up and accept that things are going to take a long time to change. But change is possible if we are willing to push through, the path of least resistance is often the most taken path and is often futile and useless. We need to start moving in ways that really take sincere effort. Many are doing that. Drug War Chronicles, and the like, mail groups, are trying hard to change perceptions.

Clive
I have been in touch with the makers of the ‘A6’ liquid, they tell me that the formula given in the studies data sheet is not theirs , their formula is a standard PG/VG mix. If the liquid is theirs – was simply mislabeled then, the best performing of all the liquids tested was provably a PG/VG mix ( A6 with no toxic compounds detected (apart from butanal) which was followed closely by the control VG solution which had some unquantifiable traces of one toxic compound but also had the lowest levels of butanal of all.

Given the extreme nature of feeding more than 10 watts to a small coil for 2.8 seconds, the results are not that bad.

I think the over riding message to take from this research is that pushing any device beyond its capabilities is not good. Which is is like saying that driving a ford fiesta becomes exponentially more dangerous when driven at 200mph, true but not greatly insightful. Fortunately most atomisers come with a built in fail safe. When they are pushed to hard they taste like shit.
Your comments showroom understand the mechanics if the research but miss the guiding principle if most science that indicates great harm from ecigs. Normally there is a design floor and normally the conclusions are given no context, enabling risk to be wildly over stated. Of course burnt coils are worse than not burnt ones, but as burnt coils are unusable, where is the actual risk? Of course running a cheap clear at over 4 volts may be worse but it tastes so bad who wouldn’t it anyway, so again where is the actual risk? It is the equivalent of saying we should take more precautionary measures.in house building because bricks are dangerous if you eat them.

There seems to be a marked and strange non- linear or emergent quality to the study’s results. The results seem quite strange. I think that the results (if repeatable) are provably a engineering problem rather than a intrinsic problem. I think it would be good to ask a chemical engineer or similar about the chemistry and physics that would be required to produce such a nonlinear result.

You state above: “hypothetical risks that have negligible magnitude?”and “products 95-100% less risky”. With regard to two recent papers, Kosmider et al and Hutzler et al, Dr Farsalinos has recently stated to me that these “I don’t think that any of the studies till now are a reason for concern, in terms of the relative safety of e-cigarettes compared to tobacco” and as the Kosmider et al scientists state: “Vapors from EC contain toxic and carcinogenic carbonyl compounds. Both solvent and battery output voltage significantly affect levels of carbonyl compounds in EC vapors. High-voltage EC may expose users to high levels of carbonyl compounds.” Robert West has recently stated that these products are and can be produced in these devices, which is a long way from the New Scientist article that Professor Hayek has his name on from 2009 that states that as there is no burning, there are none of harmful chemicals found in tobacco smoke in e-cigarette vapour. This science is clearly erronous.Looks to me like your possible estimation above of 100% less risky is on scientifically very weak ground, as even Professor West stated on radio 4 recently that, if tobacco was at 100 out of 100 for harm, then an e-cigarette would come out at 10. So, would Professor West agree that this risk is “negligable”,I wonder? Looks like ASH Scotland produced some interesting new data on children smoking e-cigarettes last week, and for the first time there is language of the dangers of e-cigarettes becoming “normailsed”: not tobacco. I believe the only thing that you could possibly accuse me of is being over-protective of children here, but it looks like data from Poland also suggested a couple of years ago that these devices were not just a “fad”. I will be interested to here your comments.

Evaluating any consumer products safety, by pushing it way past its designed use and intention is not how things are normally done.

From Dr Farsalinos:

“The main criticism to this study is that in my opinion it is highly unlikely that a top-coil atomizer like the one used in this study would be used at 4.8 volts. At a resistance of 2.2 Ohms that would represent 10.4 watts of energy delivery to the atomizer. I tried 10 watts with an EVIC battery in a Vivi Nova top-coil atomizer (for a clinical study i perfomed few months ago), and many vapers were unable to use it due to the dry puff phenomenon. Unfortunately, the researchers did not measure and could not provide any information about the resistance of the atomizers, thus it is unknown how much energy was delivered to the atomizer. In my opinion, this is crucial. Moreover, it is very important to examine new-generation (rebuildable or bottom coil) atomizers at similar conditions, since it is more likely for vapers to use such advanced atomizers for high-wattage vaping. I am certain that, due to better liquid resupply to the resistance and wick, the results will be much more favorable.

Another important point is that, although formaldehyde levels can be similar to tobacco, several other toxic chemicals are completely absent from e-cigarette vapor. For example, acrolein was completely absent although they used liquids with glycerol as the main ingredient. In fact, glycerin-based liquids had much lower formaldehyde levels in vapor compared to PG or PG/VG liquids, suggesting that they are much safer to use. As a general remark, finding few chemicals at similar levels does not mean that the risk is equivalent to tobacco cigarettes. Of course, all this information was not presented in the NYT article.

I use the 95-100% formulation to avoid excluding the possibility that there are no material risks, that the risks are de minimus or that these are less that 1/200th smoking (and so would round to 100%). I don’t think anyone has yet excluded this possibility.

I was surprised by Robert West’s statement on Radio 4. Maybe it was an unguarded moment or he was trying to be very cautious. However, it is different to what he said in writing only last month (and after the programme was recorded). In a document for the All-Party Parliamentary Group on Smoking and Health, E-cigarettes: what we know, he and others used the formulation:

From analysis of the constituents of e-cigarette vapour, e-cigarette use from popular brands can be expected to be at least 20 times safer (and probably considerably more so) than smoking tobacco cigarettes in terms of long-term health risks [1]

The source [1] is given to a paper to be published in Addiction, the peer reviewed journal of which Professor West is the editor. It is also the reason I gave 95% (=20x safer) as a lower bound or worst case. There’s obviously an element of professional judgement in these numbers but these seem to be a reasonable basis to proceed on and better than just unquantified ‘safer’, which could mean 5% safer. The aim here is to help decision makers take decisions about relative risk and the appropriate interventions to manage them – along with the possible unintended consequences.

I defer to Farsalinos analysis of the Kosminder paper, but it seems likely that there are non-linear effects when the products are tested in extreme conditions – either very hot or running dry. It’s not surprising – many chemical reactions require sufficient energy to break bonds and cause the necessary chemical changes, so once that energy is available, you would expect to see the reactions happen. But a there is a significant weakness in using studies like this as a proxy for risk: a lab experiment doesn’t necessarily simulate the user feedback in these conditions, which is likely to mean they stop using the product because it tastes funny. It’s an illustration of the pitfalls of using a rigid test regime to try to simulate actual risks. It might also signal a useful way of regulating these products – rather than testing thousands of permutations of liquid, device and operating conditions, it may be preferable to set engineering objectives – to prevent high temperature operation and to stop operation when dry… if it become clear that the users cannot do this themselves.

A final point on this: it is not just the present of a harmful substance, but the exposure and the toxicity that matters. So we would have to assess how risky this exposure actually is, including how much time the user is likely to be exposed to the relatively high levels found under certain operating conditions.

We have to be careful not to be overprotective of children if it means we are careless with the health of adults for no real reason. We should also use the term ‘adolescents’ rather than ‘children’ as it more closely describes the small population of teenage users. It is not a surprise that adolescents use e-cigarettes, any more than it is a surprise that they drink, smoke or take illicit drugs. Some teenagers do this as part of transition to adulthood and rejection of childhood. The data everywhere, including ASH Scotland, indicate that those using e-cigarettes are far more likely to be smokers than not – it is therefore possible that e-cigarettes are having a beneficial effect on them: there is no reason why ‘harm reduction’ should wait until 18. Even in e-cigarette users who had been non-smokers previously, there may be a protective effect – diverting them away from smoking onset. Hard to prove, but basically what has happened with snus in Scandinavia.

I have been carefully reading the report (should have done that, first, sorry sigh
The report contains a finding that is actually encouraging that engineering can contain, control or eliminate non-linear effects (and that is what engenders do for a job) :

“An interesting finding of our study is that no toxic carbonyls were detected in a single sample with reduced content of VG and PG. In this product (A6), the primary solvent was polyethylene glycol (PEG). It would suggest that PEG-based e-liquids might have reduced toxicity from decomposition products.”

John,
I would take that to mean: “If you are going to run artificial lab tests in which the equipment is driven far beyond the limits acceptable to a human user, then use PEG”. However this only applies to the specific toxicant group examined, PEG will probably produce other decomposition products that weren’t measured for. Just about everything does when burnt to a crisp :-))

However the compounds that were tested for are pretty good markers.
Therefore finding a carrier liquid that did not,at all, under go break down and then a partial oxidization of those break down products, at the high energy levels used by the test is significant.

Have a feeling that a particular thing that may have pushed the results at the high wattage end, was that the ecigs were kept constantly horizontal, this would mean that there was less turbulence and mixing of the liquid , hence the small portion of the liquid inclose contact with the heating element would have gotten much hotter than would happen if the ecig was moving around in a hand.

Excellent work again Clive.
For my part there can be no trust in the anti smoking campaigns as long as they rely on the bulk of their worldwide funding coming from the master settlement in the USA.
The most controversial (outspoken) opposition to new alternatives to traditional smoking seem to stem from the USA where they rely on tobacco money to fund their research and campaigns.
I am not saying all public “health” advocates funded from that source are biased but it does seem to me that going by human history, there will be those relying on that money to maintain their position and life – meaning health is the least of their concerns, they just want the money to keep flowing. If smoking declines considerably then they lose their livelihood.
This of course comes with the tax money governments have become addicted to from tobacco. At least smokers are open about having a habit while governments are the bigger addicts.

Another thing about banning flavors. If all there is is tobacco flavors in all e-cigarettes. Wouldn’t it get the children, who get them illegally, used to the taste of real cigarettes and make the transition to real smoking much more easily?

The amount of misinformation in reporting on e-cigarettes is staggering.

When reading such articles, I always ask myself the question, ‘What is the motive for reporting this’. Unfortunately, it’s never due to an altruistic concern for our health. It’s all about the fight for the pounds in our pockets.

Seems to me that it is at quite conceivable that the Health Authorities are actually being manipulated by ‘big tobacco’,into making calls for heavy regulation of e-cigs .

The reason I say this is because as it stands the barriers to market entry for e-cig makers and sellers are quite low. And most of the source product/components of e-cigs comes ultimately from china.

Therefore as it stands it will be very hard for the Big tobacco firms to retake control of the market- yes they can buy up smaller competitors, but that will not stop others starting up. The generous profit margins that go with cosy monopolies will not apply if there is a fairly free(easy to enter) market. And the big companies do not control Chinese production, of the core components of e-cigs, the only thing the big tobacco firms can control is their Trade Mark & related IP – they can stop a e-cig competitor from using their trademark and brand name on their product, but that’s all.

However if it became necessary to pass an expensive set of regulations/tests, before you can make/sell a ‘brand/model’ of e-cig, then the big firms would be back in a position of virtual monopoly over the market. And we know that the big tobacco firms are shameless past masters at manipulation, No?

I was a smoker for 39 years. When I first quit I was using nicotine lozenges but found that I could not reduce the amount of lozenges I need per day. After 2 years of using them they began to have a negative effect on my teeth. My tooth enamel was wearing away and it caused the loss of several teeth. Faced with this I knew I had to give the lozenges up but also knew I was still addicted to nicotine. The last thing I wanted to do was go back to cigarettes so I decided to try e- ciggs. I must say that they are working!! No issues with my teeth and most importantly I have not returned to cigarettes.

Another excellent blog Clive, thanks. Certainly vapers do need to become more assertive in questioning those who would reduce the HR potential of e-cigs whether deliberately or accidentally. Maybe one of the problems is simply the lack of genuine experts within this field which forces regulators to rely on advice from people whose expertise is in other fields (typically TC).

Can l raise 2 additional points:

1/ Has the negative impact of banning rebuildable devices (tamper proof requirement in art. 20 of TPD) been considered? The ability to customise devices to meet users taste/needs is one of things that makes the current market so attractive and, l believe, explains the very low relapse rate amongst 3rd generation users. Removing this will not only deny access to current users but affect future ‘switchers’, I’m sure my own experience is quite common – l persisted through 1st and 2nd generation devices instead of returning to smoking because l ‘knew’ there was an ideal device/juice combination for me somewhere on the market. Removing this diversity seems likely to increase the relapse rate with a resulting avoidable increase in smoking related illness and death.
In addition there is the likelihood that people will continue to use the remaining devices long after the coil/wick should be replaced. This will have the dual effect of creating a bad experience (and likely relapse to smoking) and/or an increase in potentially toxic components in the vapour (specifically formaldehyde and acrolein due to ‘hot spots’ and dry hits).

2/ A lighter point Clive. How on earth do you resist the temptation to strangle Stan Glantz, l admire your restraint and would like to know where l can obtain some :-)

Another point (which I’m surprised that may people in ‚public health’ organisations don’t actually get) is that that all the sorts of statements and spin many in the sector are engaging in is seriously damaging the credibility of the whole sector. If they are so ideologically-driven and ill-informed (and at times deliberately misleading) about e-cigarettes, what else are they ideologically-driven and ill-informed about?

Here in Germany I have been told by smokers that they don’t believe vaping is less harmful than vaping … or at best it’s only marginally less harmful. This mainly due to short news snippets appearing in the media where various ‘authorities’ talk about the dangers of e-cigarettes …. usually admitting they are a bit safe but that ‘the jury is out’, ‘no research’, and so on … but never addressing just what degree of harm reduction we are talking about.

My own way of getting the harm reduction point across is as follows:
Let’s assume that combustible cigarettes are 100% harmful.
If e-cigarettes are only 20% as harmful as combustible cigarettes
(seemingly a very conservative estimate),
then that is equivalent
to a reduction from smoking 20 cigarettes a day to 4 cigarettes a day.
If e-cigarettes are 5% as harmful as combustible cigarettes
(still a seemingly conservative estimate),
then that is equivalent
to a reduction from smoking 20 cigarettes a day to 1 cigarette a day.
If e-cigarettes are 1% as harmful as combustible cigarettes
(a very possible/plausible estimate),
then that is equivalent to a reduction
from smoking 20 cigarettes a day to 0.2 of a cigarette a day (1.4 cigarettes a week),
or a reduction from 7,300 cigarettes a year to 73 cigarettes a year.
That usually gets the message across.

However, on the other hand, when the subject is properly researched by journalists in longer articles, then the information provided is much better. And there is always a queue (of adults) at my local vaping shop here in Berlin – where they mix their own liquids. More people are vaping every day … and there is also good short snippet media coverage.

I had a conversation with a smoking friend a short while ago which started: “I don’t believe those are more dangerous than cigarettes”. I asked what made him think they could be, and his answer was that doctors (which turned out to be the BMA) wouldn’t be trying to get them banned if they weren’t at least as dangerous, and they may be more so because “we don’t know what’s in them”. Nothing I could say made any difference and he continues to smoke because, although he thinks he should give up, he doesn’t actually want to and thinks there is no beneficial alternative. If, as an informed adult, he decides to continue smoking then I’m fine with that. It’s his decision. But he’s not informed, he doesn’t read behind the headlines and relies on what he sees as trusted bodies “who must have done the research” in making his decisions. I’m sure he’s not alone.

All this beggaring if e-cigs are 99% or only 90% safer, are not 100% safe, nothing is, so who cares, maybe on the long run are only 33% safer… Safer is safer; a simplistic view indeed. Banning or restricting the safer alternative more than the devastating tobacco will cost lifes. The only question remains how many million smokers need to die by some sort of religious fanatisme that strives to an idealistic and unattainable 100% and rejects anything less.

The best way for not catching AIDS is total abstention or a monogamous relation, but for all those who do not live up to that ideal a preservative give them 99% protection, not 100%. Even the pope came to his senses with his stands on condoms in the AIDS debate; so why not the WHO in the tobacco control debate.

Outstanding post in an already outstanding blog. I really must write up my own positive story (I thought this morning as I bounded up stairs I used to trudge up). When I do I’ll put the link in your testimonies piece.

A great post! I agree that we should be more aggressive in challenging this supposed “consensus”.

[It wouldn’t be so bad if the risks they created were risks to their health, but they need to be more accountable for the risks they impose on others: it’s not them that bear the consequential harms arising from their misjudgements, ideological posturing and responsibility shirking.]

The one thing you didn’t cover is what allows them to escape censure (or even challenge): their constant rhetorical appeals to the permanent crisis of the Struggle Against Evil Big Tobacco, which latter is constituted as some kind of modern-day Satan.

In the context of this “struggle”, the ANTZ enjoy a privileged status of being the “good guys” who could not possibly be doing harm – because they’re supposedly the only bulwark against the far greater harm represented (or purportedly represented) by Big Tobacco Targeting Our Children (etc ad nauseam).

It’s like the use of “terrorism” in another context, as an ultimate trump card.

My favorite argument to public health argument in favor of HR approach: “Ignoring the vaping opportunity, WHO best hopes are for a reduction of 7% in tobacco prevalence by 2020 (there is a relevant source for this), relying on very unpopular political measures that have little chances of being carried through successfully. In a country (France) that has played the card well on ecig (basically, by just letting it happen), tobacco sales have been reduced by 10% in under a year.”

This can happen worldwide on a much larger scale, if media campaigns of tobacco control change their discourse to smokers from “stop smoking” to “switch to ecig”. I predict tobacco harm can be totally undercontrol in under 5 years with this change of policy. Now, that’s a reachable goal and it totally outshines WHO’s modest and yet unrealistic goals.

I think it will be very difficult for BT to compete, much as they’ll try, unless they are given a boost by regulations that force up the entry cost into the vaping business. ATM anyone can rent a shop, buy some stock from China and for minimal outlay start a business. Their cigalike market is falling as people get into the more effective and far cheaper tank devices. The margins are low. Branding is less relevant and advertising is less effective than word-of-mouth. Perhaps BT are simply trying to make a presence felt to encourage the ANTZ to push further regulation so that they can protect their primary, combustible product, as they have in Australia, and also take advantage of a highly regulated market with high barriers to entry.

BT can compete only if there is a ban on refilling – which would obviously imply a ban on home mixing. Otherwise, they sell a battery, tank and a few atomisers for £20, just like anyone else can – with a typical life time of six months to a year – then what? 72 mg concentrate is naturally as cheap as anyone can wish for. You can’t build a brand out of geeky, beautifully engineered sonic screwdrivers. They don’t look right in the mouth of some babe sitting watching the the sunset in a Monaco cafe.

When putting comments on bad articles I quite often tell them that what they are saying is killing people and are they prepared to take responsibility for that. Maybe more vapers could join me and bash them every time they step out of line.

In my life, I have seen how vaping has taken people away from smoking. I am a smoker that smoked for 50 years, determined never to stop and now, accidentally, a vaper. I promote it all the time. I know my experiences are only “anecdotes” and are not science, but they do not bear out what I am told by our rulers – NICE,BMA,BMJ etc. I hear successful “anecdotes” from my YouTube channel – hundreds and hundreds of letters, that prove to me the silly science they produce is not true. I now do not believe a word I read from any of Tobacco Control’s very many offshoots, splinter groups, WHO, charities or lobby groups. I am convinced now I see how they have treated vaping, that they have twisted facts about smoking too. They only keep the “war” (on smoking, and now vaping)going because it is a profitable industry. They are corrupt. I feel very sad that so many genuine and caring people are subsumed by them.

I want to say to THIS post “BRAVO!” Excellent! Spot on! And thank you for putting your thoughts into words.

I do have a thought on another way Public Health have harmed, now harm us, is their obsolete and outdated ideas on a “healthy plate” and what we should eat. Obesity, diabetes and other diseases are very much spawned from their guidance.

On electronic cigarettes they are blinded by Tobacco Control propaganda. They are part of it, and must do the dogma and creed of it.

WTF are you trying to say? I have never bought anything from BT. All of my products have come from small companies in Australia and the nicotine juice from China.
My health has improved tremendously, I think you are a secret agent from Big Pharma Or BT.
Why don’t you just feck off and stop trying to make profits from people who take their lives back you shallow hypocritical bastard
You are talking total shit!

Christine, if you are referring to Jon Fell, I think you might have missed the point. He’s a very thoughtful analyst and understands these companies well and how they do busienss. Whatever we may prefer they WILL be big players – the question is whether their impact will be positive. I think it will be a good thing because they have the money and reach to do this at scale, and as long as there is a lot of competition, there is nothing much they can do to harm anyone. What do people want them to do? Carry on being Merchants of Death because that makes them an easier enemy?

A great read Clive, I agree with nearly all of this.
On point 7) – ”the children” – I don’t think I’d blame anyone manufacturing / selling e-cigs for saying they should be for 18+. A decision to use a potentially-addictive product is probably best taken as an adult, and the flak they would get if they argued anything else might taint / jeopardise the whole cause. Underage smokers get hold of cigarettes somehow, and whatever the age limits some would probably get hold of e-cigs too (assuming that regs don’t make their purchase more difficult than conventional cigarettes, and don’t make e-cigs too ‘uncool’ relative to cigarettes). So I’m not sure that laws purporting to prevent the sale of e-cigs to under-18s would necessarily stop harm reduction for that age group, providing that they were not fed misinformation about the relative risks. I’m not completely sure about this, but I thought that snus in Sweden was only supposed to be purchased by those over 18 (can anyone help? Norway?); we know that snus still functions as a very effective harm reduction mechanism there.
A bigger problem, in my view, is the implication that some in the tobacco control community make that if a child / adolescent starts using tobacco / e-cigs then that must be because sellers of those products are deliberately targeting them, which just seems dishonest. I think it’s natural that a proportion of those under 18 will always want to experiment with tobacco / nicotine / alcohol – even if they were sold by a licensed state-owned monopoly, unadvertised and in standardised packaging.
Other health risks created by the public health establishment? I’d mention the general (but important) one of treating the population like babies, not trusting them to make sound decisions based on proper evidence, too often lazily (or sometimes with a more overt political agenda) setting things up as ‘Big [insert industry of choice]’ v public health. That doesn’t empower people, or reinforce the idea that they need to take responsibility for their own lives, and I can’t believe it’s good for the long-run health of the nation.

Yes – this one is slightly different, and I don’t blame the companies at all for doing this. Who would thank them for taking the harder path? Of course kids are more likely to try these products if adults have declared them off limits – so in reality there isn’t really a risk – it’s just that if everyone did as intended there would be.

There is a very simple solution to children vapeing: ban disposable e-cigs and first gen e-cigs.
I use 3rd gen devices (RBA) nowadays and any one of them is way to expensive for a youngster to get it to experiment with.
The Kayfun 3.1 on Provari V2 I vape as I’m writing this costs roughly 300 euros. No way an adolescent would get one to try it.
Even 2nd gen devices start somewhere about 30 euros, quite alot of cash.
A pack of cigarettes costs somewhere around 5 euros now (not sure, have not bought one for more than 2 years) and can easily been spilt between several kids.
HTH
godek

Sorry Christine but you are a deluded victim of tobacco industry propaganda. It is the duty of the wonderful tobacco control industry to either force you to try and quit using dangerous and ineffective (and very expensive) drug therapies, or force you to continue to smoke. The EU will assist wherever it can.

There is also the considerable risk of putting all your cessation eggs in one basket.The Stop Smoking Service has been created and expanded over more than a decade and its success lauded far and wide.

However,the latest long-term results show only an 8% one-year success rate which falls to ~5% for permanent quitters.In the absence of an alternative,it can be argued that something is better than nothing.The danger is that,because of the time,money and reputation invested in these services,advocates not only seek to disguise their lack of success,but also to disparage potentially more effective alternatives.

The current model can be adapted to allow SSS to work with ecigs/snus/nicoccino etc but not as medicinally regulated products which are proven failures.Ignoring evidence that doesn’t fit the theory is bad policy.

I will not pretend to be an academic, but all I can state is my own truth. After 47 years f smoking (apart from my two last 6 months of pregnancy) I finally feel alive again. Everyone I meet says I look 10 years younger. I feel so amazingly healthy now just after 3 months of vaping, the first two months I still smoked 3-5 cigarettes a day, but now I have no desire for them. I can comfortably walk for an hour whereas before 5 mins was my maximum.
I suffered and was phama drugged fr 30 years with panic attacks and now they have virtually disappeared. It was the cigarettes and the awful chemicals in them that were causing this problem. Now I am Free!! I defy anyone to take this away from me…….

People mostly don’t seem to realise that ‘public health’ is a corrupt enterprise to begin with, and the tobacco control industry is by far the worst part of it. It’s comprised of those who are unemployable in any other area, paid huge salaries to lie and defraud, funded by industry to protect specific fiefdoms, and ultimately dependent on protecting cigarette sales in order to keep their jobs.

The business of tobacco control is lies on an unprecedented scale – far worse than the cigarette trade was ever guilty of: there is simply no way to reduce smoking prevalence much below 20% in a developed country where it was originally higher than 40%, except substitution. There isn’t a single example of this being done; and in the UK, not only was smoking prevalence static at 20% for the 5 years between 2008 and 2013, the number of smokers actually grew. Luckily for public health, ecigs came along.

It doesn’t matter what lies they come up with, it doesn’t matter what work-creation schemes they invent, they can’t reduce smoking any more – which is a very good thing, after all, for those fat cats getting £100k a year (in the UK) or $1m a year (in the USA) for absolutely nothing at all. If smoking went the same way it did in Sweden they’d all be out of a job; Sweden will have a male smoking prevalence of 5% by 2016, since it falls 1% per year due to THR product substitution and the knock-on effect that this has (we’d call this a gateway except the term has become covered in ordure by association with tobacco control).

The tobacco control industry exists to protect tobacco tax revenues and pharma profits from drug sales for the treatement of smoking-related disease. You couldn’t find a bunch of more corrupt, endemic liars anywhere if you tried. Why on earth try to persuade them with facts? Facts don’t count much compared to $100 million in the bank – ask Dalli.

No,they don’t appear to have. For me, a year’s supply of Golden Virginia would be be 120 50gm packets – a substantial and hard to conceal volume of contraband,a nd to have it confiscated would cost around £600. A year’s supply of 72 mg concentrate, now costing £50 in the UK, and far cheaper in China, is 400 ml – less than a beer bottle and easily smuggled in one soft drink bottle, shampoo bottle, etc. Thousands of both come through the Channel Tunnel and in hold luggage every day.

When we hear the often repeated claim that Vaping is only successful for 1 in 3 (from very poor data -no info on Gen types or profile of the “switcher”),along with a totally unsubstantiated comment that Vapers represent an affluent informed tiny minority the battle will remain an uphill one . This was my take on some of the comments made by your successor at ASH at the recent GFN Conference in Warsaw. DA and ASH-UK may seemingly have moved their position in the last 6 months but it still sounds depressingly familiar to me.If they truly believed in THR they should have been knocking down doors in Westminster and Brussels not supporting+ influencing inept Junior Health Ministers.

E-cigarette growth has been, and to a very large extent remains, a grass roots word of mouth phenomenon, with experienced users passing on the knowledge they have gained from independent research to new or prospective vapers. It is hard for those who have done anything more than cursory tabloid headline research to fail to recognise that the public health establishment has consistently lied, overstated and exaggerated the risks. This has lead a very large number of us to mistrust any pronouncements from public health. Fool me once, shame on you, fool me twice… Who amongst the public health industry is recognising that the unprofessional and anti scientific behaviour of those few zealots is harming the public trust in their entire message, with all the consequential damages caused by that?

I’m a regular reader, and often applaud your “blogs” but this one is truly outstanding. Smokers are used to being defensive and apologetic, perhaps that habit has stayed with us vapers. Well, no more, time to stand up for vaping and ask hard questions of the people who would see it neutered. Bravo!

The 20mg/ml nicotine strength limit. If there are long term risks from inhaling PG, VG or flavourings albeit they are expected to be minuscule in comparison to smoking cigarettes, the restriction on strength will force people to vape more to achieve the same nicotine delivery and so expose them to more risk. Or don’t they think the compensatory smoking phenomenon will apply to ecigs for some reason?

Absolutely agree with you here the moment I m on2 4mgs. But It think eventually will cut down to 18 mgs or less. The most important thing is to get off the tobacco and all the thousands of other chemicals absorbed. and then address the nicotine which definitely is the least of the evils in the cigarettes.

Excellent point Sarah. And I don’t believe the idea behind the strength limit is anything to do with safety. The H&S limit for the sale of nicotine solution in the UK has been 75 mg/ml for years. This was decided before ecigs were invented and before the sudden concern about nicotine (except, of course, the nicotine in nicotine gum, which has made at least one school child slightly ill when handed out by tobacco controllers visiting the school). Contrary to popular belief, you’d have to bathe several square centimetres of skin in it for several minutes to suffer any effects and the potential for swallowing it should be addressed in the same way as the potential for swallowing weedkiller, bleach, slug pellets, drain cleaner, caustic soda (looks like caster sugar) etc.

It could be to prevent home mixing. I mix my own 24 mg from 72mg/ml concentrate and it works out incredibly cheaply – around £4 a week. The same amount of nicotine from prefilled cartridges would cost me £50 a week. Bear in mind that as the TPD stands, any refilling, home mixed or not, will be banned under the “leakage” clause. Preventing home mixing must be one of the prime objectives of the large companies. They can’t make money selling 72 mg concentrate. They want the “printer ink” business model – selling prefilled cartridges costing pennies for £2 each.

My other suggestion is the anti ecig industry thinks a strength limit will force people to give up nicotine altogether, when they get no satisfaction from ecigs, or they become too expensive. They can’t stand the thought of people happily vaping 24 mg liquid for the rest of their lives. It’s as if we have got one over on them and their bans and their tobacco tax rises. As you point out, this is unlikely to happen. Vapers will either vape more, buy black market liquid to refill prefilled cartridges, or go back to cigarettes.

I think the strength limit was there for a couple of reasons, firstly to appease the French who already had a 20mg/ml limit IIRC, and secondly to preserve some advantage for the med regs route. DIY mixing on the whole doesn’t seem to be much of a problem at the moment, because those that do it seem pretty clued up on both the mixing itself and the safety aspects. That could change of course if regulation means that, shall we slightly less clued up people, are forced into it to get the strengths they need.

That’s a good point. I have several 100ml childproof bottles of 72 mg in my fridge (I don’t actually have children). If strengths above 20 mg were banned, people who felt the need for 24 mg or 36 mg would be ordering litres of God knows what strength from China, in ordinary containers, and keeping it in the fridge.

I fully believe that the only risks that the Public Health anti e-cigs brigade are concerned about is the risk that ecigs pose to the Pharma industry and the whole Tobacco control movement. They certainly aren’t making decisions or statements based on scientific facts or any consideration of smokers welfare or even a desire to eradicate future deaths or harm from smoking, but sadly their own vested interests. It’s a corrupt world and the evidence of Snus sadly epitomises all that is wrong with many in public health. It also wouldn’t surprise me if tobacco use is seen in the upper echelons of the Govt Treasuries worldwide as a means to an end in that with elderly demographics increasing everywhere the 20% – 30% of the population paying tax to effectively use a product that will reduce their lives actually benefits the remaining population that do not smoke.